In a few days, June 9th-12th, a very important conference is set to take place in Lithuania that will bring all those interested in harm reduction together to discuss this year's theme "The value/s of harm reduction". The Eurasian region (Central and Eastern Europe as well as Central Asia) is home to nearly one-quarter of the world's population who inject drugs, HIV and TB are found at alarming rates.
Of importance to note, will be progress made by the bilateral and multilateral partners in embracing harm reduction as a drug policy principle and active promotion of harm reduction through political dialogue with partner countries.
In this blog, I have shared with you before some of the concerns around the changes to the way the Fund will distribute grants through the New Funding Model given what a critical role Global Fund grants have played in the region in achieving significant breakthroughs in prevention and treatment for a population that is criminalized and marginalized. In the absence of political will domestically, Global Fund grants have provided significant support to the harm reduction community to provide and access treatment, care and support.
As a major supporter and organizer of the upcoming conference, I invited Ivan Varentsov the CSAT Coordinator for EECA at EHRN, to share his thoughts on one of the themes of the conference: the need to increase and sustain donor and government investments in harm reduction.
Here I Am: Speaking out from the epicenter of the HIV epidemic in Eastern Europe and Central Asia
Guest blog by Ivan Varentsov, CSAT Coordinator for EECA at EHRN
According to UNAIDS EECA is home to the world's fastest-growing HIV epidemic. The number of people living with HIV in EECA almost tripled between 2000 and 2009. An estimated 1.4 million [1.3 million-1.6 million] people were living with HIV in 2009 compared to 530 000 [470 000-620 000] in 2000. AIDS-related deaths continue to rise in the region: an estimated 76 000 [60 000-95 000] people died from AIDS-related causes in 2009 compared to 18 000 [14 000-23 000] in 2001, a four-fold increase. Nearly 90% of newly reported HIV infections across the region are registered in Russia and Ukraine .
And the main feature of the HIV epidemic in EECA is that it is concentrated primarily among people who use drugs (PWUD). No other region in the world has experienced an epidemic so strongly and consistently concentrated among PWUD (predominantly male), and among their sexual partners. In 2010, 42% of newly diagnosed HIV cases in EECA were reported to have occurred through injecting drug use ; this proportion is lower than in past years, but higher than it is in other regions. HIV prevalence among PWUD is nearly 10% in most countries in the region .
Tuberculosis (TB) is also an increasingly important health issue in the region. It is estimated that annually about 418 000 new TB patients and 60 000 deaths due to TB are detected in the European Region. Every year, around 81 000 individuals fall sick with MDR-TB in the WHO European Region, which is home to 15 of the 27 MDR-TB high-burden countries in the world and the highest rate of MDR-TB documented in the world among new cases (32%) and previously treated cases (76%) . And in addition, TB is a leading cause of death among people living with HIV in the region.
Against the epidemiological profile, national governments in the region are reluctant to support effective, targeted services for PWUD. According to recent data, only 10% of PWUD in Eastern Europe and 36% in Central Asia can access needle and syringe exchange programmes (NSPs) . Access to opiate substitution therapy (OST) is even less common. Access to ART generally in the region is the second lowest in the world with only 23% of people in need of ART receiving it at the end of 2010.
However despite 62% of those living with HIV in the region being people who inject drugs only 22% of those receiving ART are PWID. Since ART not only saves lives but also reduces the risk of HIV transmission the failure to reach PWID with ART compounds the failure to implement harm reduction and underpins the region's escalating concentrated HIV epidemic.
Generally, OST and NSPs in the region are funded through Global Fund grants. Over the last decade, the Global Fund has played a unique and indispensable role in responding to the HIV epidemic among people who use drugs in EECA . Between 2002 and 2009, the Global Fund approved an estimated $430 million for activities targeting PWUD, of which 61%--or, $263 million--was for activities carried out in 22 countries from EECA . This amount is much higher than all other international sources combined , and has enabled the steady expansion of harm reduction programmes in the region. The Global Fund supported activities such as clean needle and syringe distribution and medical treatment for drug users (such as opioid substitution therapy), but also programmes designed to reduce stigma, mobilise communities, and improve the service and advocacy capacity of community-based programmes essential to the establishment of sustainable, nationally supported programmes. In a region where PWUD have traditionally been criminalised and excluded, the Global Fund pushed for their human rights and full inclusion.
In 2011, a sharp reduction in donor support and contributions forced the Global Fund to halt new funding and impose cost-cutting measures, and resulted in the cancellation of the Round 11 call for applications in November 2011. This affected at least 11 HIV-related applications that were prepared from EECA and were focused on harm reduction.
Instead of the Round based system in 2013 the Global Fund introduced the New Funding Model. But according to a Global Fund simulation reviewed in January 2013 just 3% of total resources would be allocated to EECA; a share that represents a 50% decrease compared with what was previously available. Both percentages could change by the time the NFM is fully launched in late 2013. However, it is disappointing that the starting point represents a decline compared with historical Global Fund allocations. With its high rates of MDRTB, increasing HIV prevalence and deplorable human rights environment, EECA needs a significantly greater share to ensure that even the basic needs for people living with / affected by HIV and TB are addressed.
EECA, which is home to a fast-growing HIV epidemic concentrated among PWUD, has already been affected and will be hit particularly hard by these changes in the near future. The Global Fund's decision to reduce funding availability based on country income ignores the fact that income is not the determining factor for the availability of HIV services for PWUD; rather, the decisive factor is political will. With few alternate funding sources available, the region's concentrated HIV epidemic is likely to grow, and many of the gains made in the last decade through Global Fund support will be lost.
That is why the national governments in the region should increase today the level of their investment into HIV epidemic counteraction and civil society in EECA countries should actively advocate for governments to take the responsibility and increase funding share now but not to wait until the Global Fund will completely terminate its relevant in-country activities and all projects and services targeted on MARPs will be just closed as it happened in Russia. The EECA's concentrated epidemic among PWID clearly calls for a response that embraces a range of science-based harm reduction interventions including needle-syringe programmes (NSPs), opioid substitution treatment (OST), peer outreach and counselling and anti-retroviral treatment (ART) for PWID and only the absence of the political will which prevents these relevant measures to be fully introduced in most of EECA countries.
Lucy Chesire: TB-HIV advocate from Kenya Board Member of the Global Fund Board Communities Delegation.
About the Here I Am campaign:The Here I Am campaign is a global call on world leaders to save millions of lives by supporting a fully funded Global Fund to Fight AIDS, Tuberculosis and Malaria. Here I Am brings the voices of people that are directly affected by AIDS, TB and malaria into dialogue about decisions that affect their lives and the lives of millions of others in their countries. Through video testimonies from all over the world, campaign ambassador advocacy, online actions and on-the-ground mobilizations, the Here I Am campaign is building collective power to end three of the world's most deadly diseases. www.hereiamcampaign.org
For more information on the Harm Reduction Conference taking place June 9th-12th ihra.net/conference
EECA here is defined as inclusive of all countries of the former Soviet Union plus all those in Eastern Europe that are not part of the European Union (with the exception of Bulgaria and Romania). Specifically, the overall list includes the following 24 countries: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Estonia, Georgia, Kazakhstan, Kosovo, Kyrgyzstan, Latvia, Lithuania, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Of these countries, all but Latvia and Lithuania have received grants from the Global Fund at some point.
EECA Fact Sheet (UNAIDS, 2010)
European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2010. Stockholm: European Centre for Disease Prevention and Control, 2011.
Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet; 372(9651): 1733-45
Tuberculosis in the WHO European Region: Factsheet 2012, WHO.
Mathers, BM. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. The Lancet, 2010. 375(9719): p. 1014-28.
Bridge J, Hunter BM, Atun R, Lazarus A. Global Fund investments in harm reduction from 2002 to 2009. Int J Drug Policy 2012; [epub ahead of print].